Healthcare Provider Details

I. General information

NPI: 1518425644
Provider Name (Legal Business Name): NANCY R HUFFMAN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 LINCOLNSHIRE DR STE A
MOUNT VERNON IL
62864-2156
US

IV. Provider business mailing address

4224 LINCOLNSHIRE DR STE A
MOUNT VERNON IL
62864-2156
US

V. Phone/Fax

Practice location:
  • Phone: 618-472-2194
  • Fax: 618-315-6461
Mailing address:
  • Phone: 618-472-2194
  • Fax: 618-315-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: